People with osteoporosis should be encouraged to exercise more to strengthen bones, improve posture and reduce falls risk, a UK expert consensus statement advises.

Writing in the British Journal of Sports Medicine, the multidisciplinary expert panel said patients with osteoporosis should not be afraid to exercise regularly, with healthcare professionals urged to adopt a positive and encouraging approach to exercise advice with a focus on ‘how to’ rather than ‘don’t do’ messages.

There was currently no UK guidance on exercise and osteoporosis, the panel noted, adding there was uncertainty among professionals and patients about how to exercise safely.

Following an evidence review and stakeholder and expert consultations, they concluded people with osteoporosis should include muscle strengthening exercise two to three days a week to promote bone strength.

In addition, they recommended brief bursts of moderate impact exercise on most days to promote bone strength (e.g. stamping, jogging, low-level jumping and hopping).

For people with osteoporosis who had vertebral fractures or multiple low trauma fractures, they recommended lower impact exercise, up to the level of brisk walking, for 20 minutes daily.

'Vertebral fracture symptoms may benefit from exercise to reduce pain, improve mobility and quality of life, ideally with specialist advice to encourage return to normal activity,' they said.

To reduce falls, people with osteoporosis should also take part in activities to improve strength and balance at least twice a week, such as Tai Chi, dance, yoga and Pilates, the panel said.

They also recommended spinal extension exercises to improve posture and potentially reduce risk of falls and vertebral fractures. (Exercise eamples available at The Royal Osteoporosis Society, which funded the development of the advice and has endorsed the statement.)

'For safety, we recommend avoiding postures involving a high degree of spinal flexion during exercise or daily life,' the panel added.

People at risk of falls should start with targeted strength and balance training to improve their confidence and stability before increasing activity levels, they said.

'Although specific types of exercise may be most effective even a minimal level of activity should provide some benefit,' the panel concluded.

'The evidence indicates that physical activity and exercise is not associated with significant harm, including vertebral fractures; in general, the benefits of physical activity outweigh the risks.'

Physical activity and exercise should be part of a broad approach that included other lifestyle changes — adequate calcium and vitamin D intake, not smoking, and cutting down on alcohol intake — combined with drug treatment, where appropriate, the statement added.

Chair of the expert panel, Professor Dawn Skelton, professor in ageing and health at Glasgow Caledonian University, said that anyone who was new to regular physical activity or who was worried about their technique could seek advice from a trained exercise instructor.

'Those with a history of falls or serious concerns about their balance can contact their local falls service,' she added.